NGN HESI Leadership and Management Exam | Latest
Update 2026/2027
Questions and Answers | A+ Grade
Based on the NCSBN Clinical Judgment Measurement Model (CJMM), HESI Leadership
Curriculum, and Contemporary Healthcare Management Principles
PART 1: NGN LEADERSHIP CASE STUDIES (60 Items)
CASE STUDY 1: Staffing Crisis and Safety on 4 West (Items 1-12)
Scenario: You are the charge nurse on a 32-bed medical-surgical unit. The staffing grid
shows 6 RNs (including yourself), 2 LPNs, and 3 UAPs for the upcoming shift. One hour
before shift change, an experienced RN calls in sick. Patient acuity is high: two patients
require telemetry monitoring, one patient requires 1:1 suicide precautions, and three
patients are total-care requiring full ADL assistance. You receive a text from Nurse B
(experienced RN): "The assignment is unsafe. I have the telemetry patient, the suicide
watch, and two total-care patients. I cannot provide safe care."
Additional Data: Hospital policy states maximum nurse-to-patient ratio of 1:5 on this
unit. The 1:1 suicide watch is a continuous, non-negotiable safety requirement per Joint
Commission standards.
Q1. (Highlight Text)
The charge nurse reviews Nurse B's assignment. Which TWO statements in the
assignment description best represent cues indicating an unsafe assignment?
,Text to Highlight: Nurse B has the telemetry patient, the suicide watch
(1:1), and two total-care patients.
Correct Highlights: the suicide watch (1:1) and two total-care patients
Rationale: This tests Recognize Cues in the CJMM. The suicide watch (1:1) is a
critical cue because it requires continuous, uninterrupted visual observation per safety
policy, making it impossible to simultaneously manage other patients. Two
total-care patients represents high-acuity, time-intensive care needs that conflict
with 1:1 observation requirements. These cues signal a system-level safety violation
requiring immediate escalation.
Q2. (Extended Multiple Choice)
What is the charge nurse's best first action?
A. Tell Nurse B, "We're all in the same boat, you'll have to manage."
B. Immediately call the nursing supervisor to request an additional RN [CORRECT]
C. Take one of Nurse B's total-care patients into your own assignment
D. Assign the UAPs to assist Nurse B with the total-care patients
Correct Answer: B
Rationale: This tests Take Action following Analyze Cues and Prioritize Hypotheses. The
core problem is a staffing shortage creating an unsafe condition that violates hospital
policy and patient safety standards. The charge nurse has limited authority to resolve
systemic staffing deficits; this requires escalation to the next management level
(nursing supervisor) who can secure additional resources or implement system-level
,contingencies (float pool, agency staff, or diversion). Option A dismisses legitimate
safety concerns. Option C compromises the charge nurse's leadership oversight. Option
D is unsafe—UAPs cannot perform 1:1 suicide watch or assume nursing responsibilities
for total-care patients.
Q3. (Matrix/Grid)
The nursing supervisor offers two potential solutions. Evaluate each option for Patient
Safety and Staffing Feasibility.
TableCopy
Staffing
Option Patient Safety
Feasibility
Appropriate
A. Pull an RN from the outpatient clinic Appropriate
[CORRECT]
B. Assign the LPN to manage the telemetry patient Appropriate Appropriate
with RN co-signature [CORRECT] [CORRECT]
C. Have Nurse B alternate 15-minute checks between Inappropriate
Appropriate
suicide watch and other patients [CORRECT]
D. Request the psychiatric unit send a sitter for 1:1 Appropriate
Inappropriate
observation [CORRECT]
Correct Answers: A (Both), B (Both), C (Safety Inappropriate), D (Feasibility
Inappropriate)
, Rationale: This tests Generate Solutions and Evaluate Outcomes. Option A maintains
appropriate scope and ratios. Option B is appropriate in states allowing LPNs to care for
stable telemetry patients with RN oversight. Option C is unsafe—suicide watch requires
continuous, not intermittent, observation; alternating checks creates lethal gaps. Option
D is ideal for safety but likely infeasible—psychiatric units rarely have spare staff, and
this relies on external unit cooperation rather than immediate actionable resources.
Q4. (Cloze/Drop-Down)
The charge nurse documents the staffing situation. Complete the incident report:
"The assignment for Nurse B violated hospital policy regarding [(1)] and created a [(2)]
risk. The charge nurse [(3)] to address the immediate safety concern."
Dropdown Options:
(1) • nurse-to-patient ratios • scope of practice • patient confidentiality • medication
administration
(2) • patient safety • financial • minor inconvenience • documentation
(3) • escalated to nursing supervisor • reprimanded the nurse • ignored the complaint •
changed the subject
Correct Answers: (1) nurse-to-patient ratios, (2) patient safety, (3) escalated to nursing
supervisor
Rationale: This tests Take Action and Communication. The violation involves ratios (1:1
watch plus other patients exceeds 1:5 maximum). The risk is patient safety (potential
for self-harm or missed care). The appropriate action is escalation up the chain of
command, not punitive or dismissive responses.
Update 2026/2027
Questions and Answers | A+ Grade
Based on the NCSBN Clinical Judgment Measurement Model (CJMM), HESI Leadership
Curriculum, and Contemporary Healthcare Management Principles
PART 1: NGN LEADERSHIP CASE STUDIES (60 Items)
CASE STUDY 1: Staffing Crisis and Safety on 4 West (Items 1-12)
Scenario: You are the charge nurse on a 32-bed medical-surgical unit. The staffing grid
shows 6 RNs (including yourself), 2 LPNs, and 3 UAPs for the upcoming shift. One hour
before shift change, an experienced RN calls in sick. Patient acuity is high: two patients
require telemetry monitoring, one patient requires 1:1 suicide precautions, and three
patients are total-care requiring full ADL assistance. You receive a text from Nurse B
(experienced RN): "The assignment is unsafe. I have the telemetry patient, the suicide
watch, and two total-care patients. I cannot provide safe care."
Additional Data: Hospital policy states maximum nurse-to-patient ratio of 1:5 on this
unit. The 1:1 suicide watch is a continuous, non-negotiable safety requirement per Joint
Commission standards.
Q1. (Highlight Text)
The charge nurse reviews Nurse B's assignment. Which TWO statements in the
assignment description best represent cues indicating an unsafe assignment?
,Text to Highlight: Nurse B has the telemetry patient, the suicide watch
(1:1), and two total-care patients.
Correct Highlights: the suicide watch (1:1) and two total-care patients
Rationale: This tests Recognize Cues in the CJMM. The suicide watch (1:1) is a
critical cue because it requires continuous, uninterrupted visual observation per safety
policy, making it impossible to simultaneously manage other patients. Two
total-care patients represents high-acuity, time-intensive care needs that conflict
with 1:1 observation requirements. These cues signal a system-level safety violation
requiring immediate escalation.
Q2. (Extended Multiple Choice)
What is the charge nurse's best first action?
A. Tell Nurse B, "We're all in the same boat, you'll have to manage."
B. Immediately call the nursing supervisor to request an additional RN [CORRECT]
C. Take one of Nurse B's total-care patients into your own assignment
D. Assign the UAPs to assist Nurse B with the total-care patients
Correct Answer: B
Rationale: This tests Take Action following Analyze Cues and Prioritize Hypotheses. The
core problem is a staffing shortage creating an unsafe condition that violates hospital
policy and patient safety standards. The charge nurse has limited authority to resolve
systemic staffing deficits; this requires escalation to the next management level
(nursing supervisor) who can secure additional resources or implement system-level
,contingencies (float pool, agency staff, or diversion). Option A dismisses legitimate
safety concerns. Option C compromises the charge nurse's leadership oversight. Option
D is unsafe—UAPs cannot perform 1:1 suicide watch or assume nursing responsibilities
for total-care patients.
Q3. (Matrix/Grid)
The nursing supervisor offers two potential solutions. Evaluate each option for Patient
Safety and Staffing Feasibility.
TableCopy
Staffing
Option Patient Safety
Feasibility
Appropriate
A. Pull an RN from the outpatient clinic Appropriate
[CORRECT]
B. Assign the LPN to manage the telemetry patient Appropriate Appropriate
with RN co-signature [CORRECT] [CORRECT]
C. Have Nurse B alternate 15-minute checks between Inappropriate
Appropriate
suicide watch and other patients [CORRECT]
D. Request the psychiatric unit send a sitter for 1:1 Appropriate
Inappropriate
observation [CORRECT]
Correct Answers: A (Both), B (Both), C (Safety Inappropriate), D (Feasibility
Inappropriate)
, Rationale: This tests Generate Solutions and Evaluate Outcomes. Option A maintains
appropriate scope and ratios. Option B is appropriate in states allowing LPNs to care for
stable telemetry patients with RN oversight. Option C is unsafe—suicide watch requires
continuous, not intermittent, observation; alternating checks creates lethal gaps. Option
D is ideal for safety but likely infeasible—psychiatric units rarely have spare staff, and
this relies on external unit cooperation rather than immediate actionable resources.
Q4. (Cloze/Drop-Down)
The charge nurse documents the staffing situation. Complete the incident report:
"The assignment for Nurse B violated hospital policy regarding [(1)] and created a [(2)]
risk. The charge nurse [(3)] to address the immediate safety concern."
Dropdown Options:
(1) • nurse-to-patient ratios • scope of practice • patient confidentiality • medication
administration
(2) • patient safety • financial • minor inconvenience • documentation
(3) • escalated to nursing supervisor • reprimanded the nurse • ignored the complaint •
changed the subject
Correct Answers: (1) nurse-to-patient ratios, (2) patient safety, (3) escalated to nursing
supervisor
Rationale: This tests Take Action and Communication. The violation involves ratios (1:1
watch plus other patients exceeds 1:5 maximum). The risk is patient safety (potential
for self-harm or missed care). The appropriate action is escalation up the chain of
command, not punitive or dismissive responses.
